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Dr. Carolyn Nessim talked with Tina Belanger before her surgery.

Two years ago, Tina Belanger tested positive for a BRCA2 gene mutation. She faced a difficult choice: a second mastectomy, or a high chance of a second round of breast cancer?

She was deeply familiar with the risks. She had a family history of breast cancer and, in 1995, had a mastectomy after being diagnosed with cancer in her right breast.

At The Ottawa Hospital’s Women’s Breast Health Centre, she was presented with an option that was pioneered five years ago and is available at only a few Canadian clinics: a prophylactic – or preventative – mastectomy, followed immediately by breast reconstruction.

After thinking through her options, she decided to have the surgery.

“Being able to have an immediate reconstruction definitely impacted my choice,” she said. “I would have been more hesitant if I knew there would be more surgery for reconstruction.”

During the surgery, Surgical Oncologist Dr. Carolyn Nessim removed the tissue in Belanger’s left breast. An hour later in the same operating room, Plastic Surgeon Dr. Kirsty Boyd reconstructed the breast with a temporary implant to establish the right shape and size. Belanger will have to undergo only one more minor operation to switch in a permanent implant.

During Tina Belanger’s surgery, Surgical Oncologist Dr. Carolyn Nessim (second from left) removed the breast tissue and Plastic Surgeon Dr. Kirsty Boyd (third from left) then immediately reconstructed the breast, all in the same operating room.

“By removing the tissue, we can lower her chance of getting breast cancer by 95 percent,” said Dr. Nessim. “The immediate reconstruction means that it’s easier emotionally and psychologically for our patients. They go to sleep with a breast and they wake up with a breast.”

Nearly two months after surgery, Belanger agreed.

“It’s definitely easier. I didn’t think about the emotional impact the first time. You’re so focused on getting the cancer removed,” she said. “When you’re doing the surgery prophylactically, it’s important to consider all of the physical and emotional things that go along with the surgery.”

The benefits extend beyond the psychological: immediate reconstruction makes the breast look more natural, and the tag-team format also has big benefits for the surgeons as they navigate the complicated surgery.

“I can reconstruct a breast mound using the patient’s own skin to cover the implant without having to operate through scarring or radiated tissue,” said Dr. Boyd.

In the end, the procedure is aimed at making the cancer experience easier for patients, said Dr. Nessim.

“It’s not just about curing cancer,” she said. “We want to make the cancer journey about quality of life as well.”

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